The clinical value of early extubation

Mandell, M. Susan; Campsen, Jeffery; Zimmerman, Michael A.; Biancofiore, Gianni; Tsou, Mei-Yung

doi:10.1097/mot.0b013e32832b2f6c

Cited by 28 publications

(15 citation statements)

References 40 publications

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“…In patients undergoing major surgery, it may be necessary to maintain mechanical ventilation support in intensive care unit. The duration of prolonged mechanical ventilation in these patients is accepted as 48 hours in some clinical studies (9,10) and as 24 hours in some studies (7,8). In our study, we accepted mechanical ventilation for more than 24 hours as "prolonged mechanical ventilation need".…”

Section: Discussionmentioning

confidence: 76%

Prolonged Mechanical Ventilation Predictors in Patients Undergoing Liver Transplantation

Can¹,

Ozer²

2019

Bezmialem Science

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Objective: Liver transplantation is the current treatment modality for end-stage liver disease. While there is increasing drive towards early extubation in patients undergoing liver transplantation, prolonged meachanical ventilation (PMV) related to various factors can be observed. We tried to determine the risk factors associated with PMV. Methods: One hundred twenty five patients (age>18 years) of with the American Society of Anesthesiology (ASA) III-IV group undergoing liver transplantation were enrolled in this retrospective study. Patient charts, intraoperative and intensive care unit follow-up forms, and electronic medical recording system were used for data collection. Patients were categorized as having received (with) or not received (without) prolonged mechanical ventilation (>24 hours), and perioperative risk factors were attempted to determine. Results: No significant intergroup differences were found in demographic variables but ASA and model for end-stage liver disease (MELD) scores were significantly higher in the with-than in the without-PMV group. Total amount of suspension of erythrocytess suspension, fresh frosen plasm, and cell-saver blood used intraoperatively was higher in the with-PMV group but difference did not reach statistical significance. Patients with-PMV had significantly higher cryoprecipitate transfusion rates than did those without-PMV (p=0.007). While no significante intergroup differences were found in mortality and lenght of hospital stay; lenght of intensive care unit (ICU) stay was higher in the with-PMV group (p=0.001). Extravascular lung water index, global ecosystem dynamics ınvestigation, and pulse volume index values obtained from pulse contour cardiac output (PiCCO) monitorization were significantly lowver in the with-than in the without-PMV group. Conclusion: We found that preoperative high ASA and MELD scores, high blood product transfusion rates, and hypovolemia supported by the PiCCO measurements are were closely related to PMV and long lenght of ICU stay.

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Section: Discussionmentioning

confidence: 76%

Prolonged Mechanical Ventilation Predictors in Patients Undergoing Liver Transplantation

Can¹,

Ozer²

2019

Bezmialem Science

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“…20 The timing of extubation after LT remains a subject of some controversy. 21,22 In a variety of surgical practices (eg, cardiac, thoracic) early extubation after major surgery has been demonstrated to be safe and to decrease costs. Application of such principles to LT is appropriate and careful intraoperative drug selection and drug dosing has allowed extubation of most patients within 8 hours of LT. Ventilator weaning protocols allow nurse and respiratory therapist engagement modifying sedation depth and ventilator settings to allow extubation following clinician order.…”

Section: System-based Considerations For Postoperative Management Resmentioning

confidence: 99%

Perioperative Care of the Liver Transplant Patient

Keegan

2016

Critical Care Clinics

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“…However, selection of patients for early extubation depends on duration of the surgery, amount of blood and products transfused, patients’ pre-operative status (MELD score), ischaemia time and status of the graft. [8081] A safe operating room extubation after liver transplantation (SORELT) prediction rule may be used to select patients for early extubation, but requires validation[82] [Table 3]. …”

Section: Fast Tracking and Early Extubationmentioning

confidence: 99%

Liver transplantation: Advances and perioperative care

et al. 2012

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Liver transplantation is one of the treatments for many-life threatening liver diseases. Numerous advances in liver transplant surgery, anaesthesia and perioperative care have allowed for an increasing number of these procedures. The purpose of this review is to consider some of the important advances in perioperative care of liver transplant patients such as pre-operative evaluation, intraoperative monitoring and management and early extubation. A PubMed and EMBASE search of terms “Anaesthesia” and “Liver Transplantation” were performed with filters of articles in “English”, “Adult” and relevant recent publications of randomised control trial, editorial, systemic review and non-systemic review were selected and synthesized according to the author's personal and professional perspective in the field of liver transplantation and anaesthesia. The article outlines strategies in organ preservation, training and transplant database for further research.

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The clinical value of early extubation

Cited by 28 publications

References 40 publications

Prolonged Mechanical Ventilation Predictors in Patients Undergoing Liver Transplantation

Prolonged Mechanical Ventilation Predictors in Patients Undergoing Liver Transplantation

Perioperative Care of the Liver Transplant Patient

Liver transplantation: Advances and perioperative care

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